What is Scoliosis? - Symptoms, Causes, Images & Treatment

Scoliosis is a spinal disease in which the spine of the patient is curved to one side. Adolescents are more commonly affected by this disease. Usually, the curve is shaped as either S or C three-dimensionally. In some cases, the curve is stable and does not change over time, while in some instances, the degree of the curve worsens over time.

There are generally three types of scoliosis.

These are:

1. Idiopathic Scoliosis
2. Congenital Scoliosis
3. Neuromuscular Scoliosis.

Signs and symptoms of scoliosis are:

1. Uneven shoulder of the affected person
2. Uneven waist of the person affected by scoliosis
3. One side of the hip is higher than the other.
4. One side of the ribcage is humped out slightly.
5. One-shoulder blade appears more dominant than the other.
6. When bending forward, there is a prominence on one side of the back
7. Uneven length of the legs.
8. The uneven posture of the body

The person may have pain in the neck, shoulder, lower back, spine, buttock. In severe cases, cardiac and respiratory problems can also occur. Mobility is also reduced, especially when twisting the torso. In mild cases, the person can also experience constipation due to the strain on the stomach area.

There are several causes of scoliosis, such as neuromuscular conditions, inherited disease, and environmental factors. Some of them are:

1. Congenital Conditions: Scoliosis occurs when there is abnormal development of the spine before birth.
2. Spinal Abnormalities: Neuromuscular conditions, such as spina bifida, spinal cord injury, and cerebral palsy may lead to scoliosis.
3. Injuries: Injuries, such as chest injuries, during infancy or childhood may also lead to scoliosis. 
4. Muscle Spasm: If there is a lot of spasms in the major muscle of the back, then the spine could shift in one direction. It may result in the curving of the spine.
5. The difference in leg height (Leg length discrepancy): When there is a significant difference in the length of the two legs, then scoliosis may be caused.
6. Inflammation: If an area to either side of the spine is inflamed for an extended period, scoliosis may occur. Scoliosis can also be caused due to appendicitis and pneumonia.
7.  Infections in the spine 

Factors that increase the risk of scoliosis are:

1. Congenital Scoliosis: Congenital scoliosis causes the curving of the spine at the time of birth. So, the risk factors, in this case, are generally the complications that a pregnant woman faces and the factors the child was exposed to during the surgery. However, hyperthermia, twin gestation, and Insulin-dependent diabetes are the most common factors.
2. Neuromuscular Scoliosis: It is caused by the presence of any neurological condition. Neuromuscular or Neurological diseases like Spinal muscular atrophy, Cerebral palsy, Spina bifida, and Muscular dystrophy are the main reasons for causing neuromuscular scoliosis.
3. Idiopathic Scoliosis: It is also known as adolescent scoliosis. It is the most common type of scoliosis, constituting about 80 per cent of all cases. Risk factors may include age, sex, and family history of scoliosis.

1. Scoliosis is an abnormal spine curving that mainly affects the mid-back or thoracic reason between the shoulder blades. 
2. However, from the rearview, if the spine seems to be tilted or twisted to any of the sides, then it is scoliosis. 
3. Unfortunately, many cases, including adolescent scoliosis, cannot be prevented. However, the progression can be minimised. 
4. The use of spinal bracing is the most commonly used option for teenagers with progressive cases of scoliosis. 
5. Unfortunately, there are very limited options to prevent scoliosis in adults. 
6. All we can do is try to reduce the pain associated with scoliosis. Adding some exercises to increase the range of motion and flexibility will also help in this case.
7. It has been reported that deficiency of vitamin D may play a role in the development of adolescent idiopathic scoliosis. Further, supplementation with vitamin D and calcium may improve bone strength and prevent curve progression.

Scoliosis is usually detected and confirmed with the help of physical examination, X-ray, CT, and MRI scans. 

1. Cobb Method: It is used for measuring the curve, and the doctor determines the severity based on the degree of the curve. The more the degree of curve, the more will be the severity. Twenty-five to thirty degrees of the curve is considered significant, and the 45-50 degrees curve is severe.
2. Adam's Forward Bend Test: Paediatricians generally use this test. In this test, the patient is told to lean forward with their feet together and bend to 90 degrees at the waist. From this angle, any abnormality in the spine can be detected easily. It is generally used as a screening test and can determine potential problems. But this cannot detect the correct and exact type of severity of deformation. 
3. X-ray: The image of the spine is obtained on a film using radiation to determine the degree of deformation. 
4. CT scan: An image is created by using an x-ray. It is used to find the shape and size of the spinal canal.
5. Magnetic resonance imaging: The doctor may also advise the patients to undergo magnetic resonance imaging if there is a suspicion that scoliosis may be caused due to underlying medical disease, such as an abnormality in the spinal cord.

How to prepare for the doctor's consultation?

1. If you are experiencing the sign of scoliosis in you or your child, book an appointment with the doctor. Visit the hospital at the scheduled time and date of the appointment and register yourself at the counter by paying the registration and consultation fee.
2. Your doctor asks you about the symptoms you are experiencing, such as pain. Provide detailed information about the signs.
3. The doctor may also seek information about your work and your medical and family history. It will help in determining your risk of scoliosis. 
4. The doctor then physically examines you or your child, as the case may be, and may recommend certain diagnostic tests, such as an x-ray, CT scan or MRI. 
5. You may ask your doctor about the precautions you need to follow to avoid pain or disease progression. 

For children, treatment may include Observation, Bracing, Surgery, and Physical Therapy. Out of all these, bracing and surgery are widely used.

1. Bracing: It is usually done when the bone is in the growing stage to avoid surgery. It is the most effective method for children and was found to be reducing the curve significantly.
2. Surgery: Doctors generally recommend surgery where the curvature is more than 45 degrees and in the case of spina bifida and cerebral palsy in which the curve interferes with sitting. Highly specified spinal surgeons perform surgery. It is usually impossible to completely straighten the spine affected by scoliosis. Surgery of scoliosis is mainly of two types, Anterior fusion and Posterior fusion:
   1. In anterior fusion, a slight cut is made at the side of the chest wall.
   2. In posterior fusion, an incision at the back is done, and metallic instruments are used to correct the curve.
3. Physiotherapy: Mild cases of scoliosis can be managed through exercises and there may be no requirement for surgery. There are several exercises that provide relief from symptoms of scoliosis. These are arm and leg raises, pelvic tilt, stretching latissimus dorsi muscles and abdominal press.

1. If Left untreated, scoliosis may worsen and lead to long-term severe physiological and emotional complications. 
2. In severe cases of scoliosis where there is more curve than 50 degrees, it can cause the spine to rotate, resulting in decreased lung capacity and can also cause problems related to the heart. 
3. Individuals with untreated scoliosis for the long term may result in Spondylosis. It is inflammatory arthritis, mainly affecting the spine and large joints.